Long after the pain and shock have faded, plenty of questions and uncertainty remain.

Three days after Chiefs running back Jamaal Charles suffered a season-ending knee injury, joining tight end Tony Moeaki and safety Eric Berry with torn anterior cruciate ligaments, the Chiefs are attempting to make sense of how they could be dealt such a devastating hand. In three weeks, three of their starters were lost for the season, placed on injured reserve with the same injury.

“Sometimes through preparation, sometimes through just freak happenings,” coach Todd Haley said. “We’ve seen a little bit of each.”

After a mostly relaxed preseason in which the Chiefs, ironically, designed training camp to ease players back into football conditioning and prevent injuries after the more than four-month NFL lockout, they might be wondering if they could’ve done more to prevent an injury that occurs in a split second but affects an entire season.

James Gladstone is an assistant professor of orthopedics at the Mount Sinai Medical Center in New York. He said it’s tempting to think the lockout or Haley’s preseason strategy contributed to the Chiefs’ misfortunes. Instead — and for better or worse — there was little the team could’ve done to prevent those injuries, he said.

Moeaki was injured in the Chiefs’ final preseason game at Green Bay. Berry, trying to change directions, tore his ACL early in the first quarter Sept. 11 against Buffalo. He will have surgery next week; procedures are usually scheduled weeks after the initial injury to allow any swelling to subside. And Charles, the team’s dynamic back who finished second in the NFL in rushing last season, was injured near the sideline this past Sunday against the Lions.

Each injury happened in an instant, and what follows, Gladstone said, is a long spell of inactivity, followed by surgery and rehabilitation. He said players almost never try to run for 10 to 16 weeks after surgery, and there’s time spent after that trying to cut and pivot — movements common among positions that rely on quickness and agility, such as those played by Berry and Charles. Players aren’t often 100 percent for about six months.

And most times, the first stage of recovery isn’t even the most difficult.

Priest Holmes, the former Chiefs running back, tore his ACL during a spring practice before his senior season at the University of Texas. The injury occurred, he said, after a long practice run; as he turned to head back toward the huddle, a teammate tripped, falling into Holmes’ leg and shredding the ligament that connects the thighbone and shinbone.

“A number of things, of course, cross your mind,” he said. “Definitely, self-worth is one of the things that cross your mind. You immediately understand as a football player, when you’re injured, you’re at the back of the bus.”

Holmes said many injured players begin to think of their futures in football. In Holmes’ case, his fears were rooted in reality: Ricky Williams passed Holmes on the Longhorns’ depth chart, going on to shatter rushing records and win the Heisman Trophy, and amid fears that Holmes couldn’t stay healthy, the Texas running back went undrafted in 1997, about two years after his injury.

“When you have an ACL tear,” Holmes said, “there’s just time that’s in front of you now. That’s the thing that really hurts.”

That, and the question of how the injury will affect a player’s career. Gladstone said ACL replacement surgery — a healthy ligament is usually taken from either a cadaver or a different part of the patient’s leg — is usually enough to repair the injury. He added that a repaired ligament is in no greater danger of being torn again, despite examples such as the one endured by Carolina Panthers linebacker Thomas Davis, who on Sunday tore the ACL in his right knee for the third time in less than two years.

Even for players suffering from their first tear, learning to trust the injured knee is an obstacle.

“The biggest issue is the confidence factor,” Gladstone said. “… That can take a little while.”

Still, there’s no guarantee a player won’t suffer long-term effects. In 2006, the American Journal of Sports Medicine published the findings of a study that centered on how NFL players performed after suffering ACL tears. Gauging the results from running backs and wide receivers over five years, it found that 21 percent of players were unable to return at all. Those who did play again saw a one-third decrease in productivity, according to the study, usually associated with knee stiffness and loss of strength.

“Basically telling us,” Gladstone said, “that it’s not a slam dunk.”

The doctor emphasized that there are few absolutes in knee injuries, how they’re suffered or how athletes respond to them. In Holmes’ case, he actually became faster. Before his ACL tear, he ran the 40-yard dash in 4.5 seconds; after his recovery, his time had been trimmed to 4.3 seconds. Even now at age 37, he said, his surgically repaired left knee is stronger than the one that never required surgery.

“I never really understood it,” he said, “to this day.”

Of course, Holmes went on to further beat the odds, signing with Baltimore as an undrafted free agent in ’97, then becoming a star with the Chiefs. He reached three Pro Bowls and was selected offensive player of the year in 2002 by The Associated Press.

He said that, even immediately after his ACL tear, he knew that his work ethic would carry him toward a full recovery — even if he had to do it mostly alone. Injured players see their teammates only in passing, and support often comes only from team leaders or close teammates.

He said strong-willed players are able to bounce back anyway.

“It goes back to how these athletes are going to be built and what they’ve done in the past to get to this point,” he said. “… Those individuals can bounce back, because they have something innate and internal that allows them to have that drive: That when no one is there watching, they’re still pushing themselves and doing the things necessary.”

Holmes said the following months will be a test for Moeaki, Berry and Charles — to say nothing of what the Chiefs face without them.

“Right now,” the former All-Pro rusher said, “this is a road that they have to travel alone. If they’re able to bounce back and show their fortitude, then they’ll be back — and they’ll come back just as strong as they were.”

BigChiefDave:"Anyone who thought we would only be in Iraq for a few years is either stoned or just stoopid."
"It is unknowable how long that conflict will last. It could last 6 days, 6 wks. I doubt 6 mths." Rummy 2/7/03